Temporary Device Implantation in CIED-Dependent Patients – Safety and Outcomes

Background:
CIED-dependent patients present a unique problem in the setting of CIED-related infection requiring extraction. These patients require temporary device implantation, theoretically elevating risk for relapse infection and further complications.

Methods:
A retrospective analysis of all CIED extraction procedures in the Sheba Medical Center from January 2013 to September 2016 was performed. CIED-dependent patients were defined as patients with no underlying rhythm below 30 bpm during device interrogation. Clinical course and outcomes were compared with those of patients nondependent on CIEDs.

Results:
Of 141 patients who underwent extraction for pocket or systemic infections, 34 (24.1%) were CIED-dependent, of which 21 (61.7%) had pocket infections and 13 (38.3%) had systemic infections. All CIED dependent patients underwent immediate pacemaker active lead implantation via the Jugular Vein of the contralateral side to the extracted device. The lead was attached to an external pacer. In all cases blood cultures turned negative prior to re-implantation. There was no significant difference in hospitalization time (12± 9 vs. 11± 8 days; p=0.92) between the two groups. The mean time to re-implantation was significantly shorter in CIED-dependent patients (9± 4 vs. 96± 80 days; p<0.01). There were no new or relapsed infections while the temporary device was in place. Only 1 patient in the CIED-dependent group (2.9%) had relapsing infection of the CIED pocket within the first year post extraction, compared with 2 patients in the nondependent group (1.9%). All 3 relapses were pocket infections on the contralateral side of the original implant. All cause mortality at one-year was similar in both patient groups (26.4% vs. 26.2%; p=0.98).

Conclusion:
Our results illustrate the safety of contralateral temporary device implantation in CIED-dependent patients. Hospitalization time, mortality rates, and relapsing infections were similar to those of none-dependent patients, even though time to re-implantation was significantly shorter.